Randomized Comparison of 64-Slice Single- and Dual-Source Computed Tomography Coronary Angiography for the Detection of Coronary Artery Disease

ObjectivesThe purpose of this study was to analyze the influence of a systematic approach to lower heart rate for coronary computed tomography (CT) angiography on diagnostic accuracy of 64-slice single- and dual-source CT.BackgroundCoronary CT angiography is often impaired by motion artifacts, so that routine lowering of heart rate is usually recommended. This is often conceived as a major limitation of the technique. It is expected that higher temporal resolution, such as with dual-source 64-slice CT, would allow diagnostic imaging even without systematic pre-treatment for lowering the heart rate.MethodsTwo hundred patients with suspected coronary artery disease were first randomized to either 64-slice single-source CT (n = 100) or dual-source CT (n = 100) for contrast-enhanced coronary artery evaluation. In each group, patients were further randomized to either receive systematic heart rate control (oral and intravenous beta-blockade for a target heart rate ≤60 beats/min) or receive no premedication. Evaluability of datasets and diagnostic accuracy were compared between groups against the results obtained from invasive angiography.ResultsSystematic pre-treatment lowered heart rate during CT coronary angiography by 10 beats/min. Heart rate control significantly improved evaluability in single-source CT (93% vs. 69% on a per-patient basis, p = 0.005), whereas it did not in dual-source CT (96% vs. 98%). In evaluable patients, sensitivity to detect the presence of at least 1 coronary stenosis by single-source CT was 86% and 79%, respectively, with and without heart rate control (p = NS). For dual-source CT, it was 100% and 95%, respectively (p = NS). The rate of correctly classified patients, defined as evaluable and correct classification as to the presence or absence of at least 1 coronary artery stenosis, was significantly improved by heart rate control in single-source CT (78% vs. 57%, p = 0.04), whereas there was no such influence in dual-source CT (87% vs. 93%).ConclusionsSystematic heart rate control significantly improves image quality for coronary visualization by 64-slice single-source CT, whereas image quality and diagnostic accuracy remain unaffected in dual-source CT angiography. Improved temporal resolution obviates the need for heart rate control

Appropriateness of oral anticoagulants for long-term treatment of atrial fibrillation in older people: results of an evidence-based review and international consensus validation process (OAC-FORTA 2016)

Background: Age appropriateness of anticoagulants for stroke prevention in atrial fibrillation is uncertain. Objective: To review oral anticoagulants for the treatment of atrial fibrillation in older (age >65 years) people and to classify appropriate and inappropriate drugs based on efficacy, safety and tolerability using the Fit-fOR-The-Aged (FORTA) classification. Methods: We performed a structured comprehensive review of controlled clinical trials and summaries of individual product characteristics to assess study and total patient numbers, quality of major outcome data and data of geriatric relevance. The resulting evidence was discussed in a round table with an interdisciplinary panel of ten European experts. Decisions on age appropriateness were made using a Delphi process. Results: For the eight drugs included, 380 citations were identified. The primary outcome results were reported in 32 clinical trials with explicit and relevant data on older people. Though over 24,000 patients aged >75/80 years were studied for warfarin, data on geriatric syndromes were rare (two studies reporting on frailty/falls/mental status) and missing for all other compounds. Apixaban was rated FORTA-A (highly beneficial). Other non-vitamin K antagonist oral anticoagulants (including low/high-intensity dabigatran and high-intensity edoxaban) and warfarin were assigned to FORTA-B (beneficial). Phenprocoumon, acenocoumarol and fluindione were rated FORTA-C (questionable), mainly reflecting the absence of data. Conclusions: All non-vitamin K antagonist oral anticoagulants and warfarin were classified as beneficial or very beneficial in older persons (FORTA-A or -B), underlining the overall positive assessment of the risk/benefit ratio for these drugs. For other vitamin-K antagonists regionally used in Europe, the lack of evidence should challenge current practice

Laser-induced real-space topology control of spin wave resonances

Femtosecond laser excitation of materials that exhibit magnetic spin textures promises advanced magnetic control via the generation of ultrafast and non-equilibrium spin dynamics. We explore such possibilities in ferrimagnetic [Fe(0.35 nm)/Gd(0.40 nm)]$_{160}$ multilayers, which host a rich diversity of magnetic textures from stripe domains at low magnetic fields, a dense bubble/skyrmion lattice at intermediate fields, and a single domain state for high magnetic fields. Using femtosecond magneto-optics, we observe distinct coherent spin wave dynamics in response to a weak laser excitation allowing us to unambiguously identify the different magnetic spin textures. Moreover, employing strong laser excitation we show that we achieve versatile control of the coherent spin dynamics via non-equilibrium and ultrafast transformation of magnetic spin textures by both creating and annihilating bubbles/skyrmions. We corroborate our findings by micromagnetic simulations and by Lorentz transmission electron microscopy before and after laser exposure.Comment: 19 article pages, 12 supplementar

Cardiac computed tomography: indications, applications, limitations, and training requirements: Report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT of the European Society of Cardiology and the European Council of Nuclear Cardiology

As a consequence of improved technology, there is growing clinical interest in the use of multi-detector row computed tomography (MDCT) for non-invasive coronary angiography. Indeed, the accuracy of MDCT to detect or exclude coronary artery stenoses has been high in many published studies. This report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT (WG 5) of the European Society of Cardiology and the European Council of Nuclear Cardiology summarizes the present state of cardiac CT technology, as well as the currently available data concerning its accuracy and applicability in certain clinical situations. Besides coronary CT angiography, the use of CT for the assessment of cardiac morphology and function, evaluation of perfusion and viability, and analysis of heart valves is discussed. In addition, recommendations for clinical applications of cardiac CT imaging are given and limitations of the technique are describe

Observation of fluctuation-mediated picosecond nucleation of a topological phase

peer reviewedTopological states of matter exhibit fascinating physics combined with an intrinsic stability. A key challenge is the fast creation of topological phases, which requires massive reorientation of charge or spin degrees of freedom. Here we report the picosecond emergence of an extended topological phase that comprises many magnetic skyrmions. The nucleation of this phase, followed in real time via single-shot soft X-ray scattering after infrared laser excitation, is mediated by a transient topological fluctuation state. This state is enabled by the presence of a time-reversal symmetry-breaking perpendicular magnetic field and exists for less than 300 ps. Atomistic simulations indicate that the fluctuation state largely reduces the topological energy barrier and thereby enables the observed rapid and homogeneous nucleation of the skyrmion phase. These observations provide fundamental insights into the nature of topological phase transitions, and suggest a path towards ultrafast topological switching in a wide variety of materials through intermediate fluctuating states. © 2020, The Author(s), under exclusive licence to Springer Nature Limited.Leibniz Association Grant no. K162/2018 (OptiSPIN